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Updated: Jul 3, 2026
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Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Diagnostic options for patients with refractory GERD
Fernando Fornari1, Daniel Sifrim
1Faculty of Medicine K.U. Leuven, Lab G-I Physiopathology, O&N Gasthuisberg, Leuven, Belgium.
Current Gastroenterology Reports
|July 16, 2008
Summary
Refractory gastroesophageal reflux disease (GERD) affects one-third of patients on proton pump inhibitors (PPIs). New diagnostic tools like impedance-pH and bilirubin monitoring aid in evaluating persistent GERD symptoms unresponsive to standard treatment.
Area of Science:
- Gastroenterology
- Digestive Health
- Esophageal Disorders
Background:
- Refractory gastroesophageal reflux disease (GERD) is characterized by persistent symptoms despite proton pump inhibitor (PPI) therapy.
- An estimated one-third of GERD patients on daily PPIs experience treatment failure, necessitating further investigation.
- Identifying the cause of persistent symptoms is crucial for effective management.
Purpose of the Study:
- To review diagnostic tools for patients with refractory GERD.
- To highlight the utility of advanced monitoring techniques in evaluating treatment-resistant GERD.
- To guide the selection of appropriate diagnostic methods for refractory GERD.
Main Methods:
- Review of diagnostic modalities for refractory GERD.
- Discussion of upper gastrointestinal endoscopy with biopsy analysis.
- Evaluation of esophageal pH monitoring, impedance-pH monitoring, and bilirubin monitoring.
Main Results:
- Conventional diagnostics include endoscopy and ambulatory pH monitoring during PPI therapy.
- Impedance-pH monitoring effectively detects persistent weakly acidic reflux.
- Bilirubin monitoring identifies increased esophageal bile exposure.
Conclusions:
- Advanced techniques like impedance-pH and bilirubin monitoring offer valuable insights into refractory GERD.
- Gastric pH monitoring is primarily indicated for suspected PPI resistance.
- Accurate diagnosis is essential for optimizing management of refractory GERD.
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